Nitrous Oxide: A Party Drug with Irreversible Risks

Physicians warn nitrous oxide misuse can cause life-changing nerve damage

Adventist Health Glendale physicians are raising awareness about recreational “laughing gas” use, an emerging public health concern that can lead to numbness, weakness, cognitive changes, spinal cord injury, and lasting neurological damage.

Just weeks earlier, he had been healthy. Now he was walking into his doctor's office with a walker, struggling with numbness and weakness that had spread through his arms and legs.

What initially appeared to be the aftermath of a fall soon revealed something far more alarming. The cause wasn't a traumatic injury or a rare neurological disease. It was recreational nitrous oxide use, commonly known as "laughing gas."

By the time he came to see Dr. Sevana Manukian, a board-certified family medicine physician with Adventist Health Glendale, he had already sought medical care for a recent ankle injury. During his follow-up appointment, he described rapidly worsening numbness, tingling, and weakness. He had already begun connecting the dots himself.

"He had figured it out before he came to see me," Dr. Manukian says. "He looked it up online, found other people describing similar symptoms, and realized the nitrous oxide use was connected to what was happening to his body."

His experience reflects what Adventist Health Glendale physicians say is an increasingly important public health concern. Once associated primarily with dental offices and whipped cream chargers, nitrous oxide has become a popular recreational drug, particularly among young adults. While many users perceive it as harmless because of its brief euphoric effects, repeated use can interfere with the body's ability to use vitamin B12 effectively, causing serious nerve damage, spinal cord injury and neurological symptoms that may not fully reverse. Even when vitamin B12 levels appear normal on a blood test, the vitamin may not be functioning properly in the body.

That is why early recognition matters.

"The spinal cord is an unforgiving part of the central nervous system," says Dr. Tigran Khachatryan, neurology expert with Adventist Health Glendale. "Some patients improve, but recovery is rarely complete when the damage is advanced."

For Dr. Manukian, the encounter was a wake-up call. As a primary care physician, she routinely screens patients about alcohol, tobacco, vaping, and other substances. Recreational nitrous oxide use, however, had not traditionally been part of that conversation.

"That is one of the scariest parts," she says. "If you are not aware that it is being used this way, you may not think to ask about it. And if you don't ask, you may not recognize it until the damage has already begun."